For an individual with anorexia nervosa, it can feel like a constant struggle to quiet the “noise” within the brain. As we know from neurological research, a misfiring of a neurochemicals within the AN brain cause a flood of panic, negative self-talk and anxious thoughts, or “noise” at mealtime.  When an individual sits down to a meal publicly, these anxious thoughts are heightened. Individuals struggling with AN report that this anxiety is rooted in fear of public perception (e.g. how an individual’s food choices and habits may be perceived by others). In addition to this cognitive “noise”, individuals struggling with AN may experience the physical symptoms of anxiety while eating in public such as: fast heart rate, sweaty palms, a sensation of a lump in their throat, nausea, and stomach pain. It is easy to imagine that is far from an enjoyable experience. Over time, such sensations and experiences often lead to avoidance of public or social meals all together.

The experience of judgement, shame and anxiety when eating in public is not specific to anorexia nervosa. Nearly all individuals struggling with an eating disorder report discomfort while dining around peers, loved ones or strangers. For example, those with binge eating disorder have reported feeling anxious or embarrassed when eating in public. The negative “eating disorder voices” in a binge eating situation may harp on what those around them are thinking about the amount of food on their plate or the contents of their plate. Alternatively, Individuals who struggle with restricted eating behaviors may experience fear that those around them will urge them to eat more. This meal-related “noise” will typically result  in the exacerbation of the individual’s eating disordered behavior in an effort to alleviate the anxiety.

If you or a loved one are struggling to eat in public, it may be time to seek professional help. Programs such as therapeutic meal support can help re-establish mealtime as a rewarding and pleasant experience. Supported meal programs provide breakfast, lunch and dinner to clients in a small, relaxed, therapeutic group setting. Each meal takes place in the presence of a trained therapist facilitator. In an effort to quiet this cognitive “noise” conversation is encouraged amongst clients to distract from the experience of any negative self-talk/anxiety and promote normal, healthy social interaction during mealtime

In addition to re-establishing mealtimes as a positive social experience, additional goals of our supported meal program target disordered eating rituals, rules and/or restrictions. While some clients present with overly rigid rules about when to eat (only before 7pm, only when starving etc), others may demonstrate chaotic eating, grazing or a starving/overeating cycle. For all clients, recovery starts with establishing a stable and consistent meal schedule—breakfast, lunch, and dinner, with snacks in between. Different food types are presented or encouraged and appropriate portions modeled at every meal to educate our clients on what constitutes a balanced, healthy meal. In time, participants can practice their own food selection, portioning and connecting with body cues of hunger and fullness. Our hope is that once our clients have established better “what, when and how” skills, they may be able to re-engage with dining experience in a meaningful way.

At Columbus Park we feel supported meal programming is paramount to recovery. For more information about this program contact us here

References:

https://www.nationaleatingdisorders.org/blog/dear-lesley-why-so-difficult-to-eat-public